Individuation/Attachment Relationships Mediating Between Overall Family Boundaries and Drive for Thinness and Bulimia Behaviors Reported by College Females

One hundred twenty–four college females completed measures of overall family enmeshed/disengaged boundaries, attachment to parents, autonomy from parents, differentiation from peers, and thinness and bulimia behaviors. Bootstrapping results for multiple mediators highlighted the specific indirect paths that the attachment/individuation process has in the relationship between an overall enmeshed/disengaged structural family boundary and excessive worries about thinness and bulimia. Attachment with parents had strong unique indirect effects for concerns about thinness. The unique influence of connection with parents was balanced with the unique influence of feelings of autonomy from parents in the indirect path for bulimia. Historically, theory and research on Anorexia Nervosa (AN) and Bulimia Nervosa (BN) has focused on psychodynamic and family system perspectives. Object relation theorists assert that difficulties with attachment/individuation issues underlie the development of AN and BN (Bruch, 1973). The findings from studies with clinical (Latzer, Hochdorf, Bachar, & Canetti, 2002; Maine, 2011) and non-clinical, young adult females (Frank & Jackson, 1996; Friedlander & Siegel, 1990; Rhodes & Kroger, 1992) support the relevance of attachment and individuation variables to the etiology of AN and BN. Family theorists argue that an individual’s eating disorder is rooted in the family's style of interacting, which is related to the process of individuation (Minuchin, Rosman, Ideas and Research You Can Use: VISTAS 2013 2 & Baker, 1978). Minuchin et al. (1978) described the family structure in families with an adolescent who has anorexia as characterized by enmeshment, conflict avoidance, the existence of cross-generational alliances, rigidity, and overprotective parenting. Other researchers found families with an adolescent who has bulimia more openly hostile and chaotic than enmeshed (Humphrey, 1986, 1989; Kog & Vandereycken, 1985; Schwartz, Barrett, & Saba, 1985). These family patterns appear to be different but the effects of both of them on adolescents are the same. Both family patterns disrupt the individuation process so that females who have anorexia have difficulty transitioning from childhood to adolescence (Bruch, 1973), and females who have bulimia encounter issues moving from adolescence into adulthood (Humphrey & Stern, 1988; Root, Fallon, & Freidrich, 1986). The Maudsley Family Based Treatment (MFBT) model (Lock & Le Grange, 2005; Lock, Le Grange, Agas, & Dare, 2001) currently is the most promising treatment for adolescents with early onset AN. The MFBT model combines structural family therapy techniques with strategies to foster the individuation process in the young female. The approach covers three phases of outpatient treatment over 6-12 months. In the first phase, parents are coached to help them find effective ways to take charge over their daughters’ eating. The adolescent also is encouraged to join with her siblings for additional support. In phase two, parents allow their daughter to eat her own meals as long as she gains weight. In phase three, the focus moves to helping the daughter to establish a positive identity by making more decisions typical of adolescents, developing relationships with peers, dating, and exploring career and educational goals. The importance of age differences associated with the treatment of AN and BN is seen in the current outcome research with families. For example, research studies comparing the MFBT with individual therapy for the treatment of AN found family therapy to be more effective, especially for younger adolescents with less than 3 years of having AN (Eisler et al., 1997; Russell, Szmukler, Dare, & Eisler, 1987; Russell, Dare, Eisler, & Le Grange, 1992). Both family and individual treatment were found to be less effective for females over the age of 18 with AN (Dare, Eisler, Russell, Treasure, & Dodge, 2001). Although individual based cognitive behavioral and interpersonal therapies have been found to be effective treatments for BN in patients ages 18–24, researchers are just beginning to compare the effectiveness of family and individual therapy with younger adolescents with BN. Recently, Lock, Le Grange, and Crosby (2008) found that MFBT was more effective than supportive therapy for adolescents below the age of 18 with BN and that changes in cognitions appeared to mediate treatment outcome. Therefore, research is needed focusing on family factors and underlying attachment/individuation processes in adolescents and young adults at risk for AN and BN so that important age differences that may underlie treatment outcome can be identified. Although the extant research on eating disorders (EDs) has investigated attachment and individuation variables and family factors linked to AN and BN in adolescents and young adults, these variables generally have been studied separately. Very few studies have combined family and attachment/individuation variables to sort out moderation or mediation effects between them, and no studies have investigated multiple mediators simultaneously. Ideas and Research You Can Use: VISTAS 2013 3 The purpose of this study was to investigate multiple individuation/attachment variables as simultaneous mediators between overall enmeshed/disengaged family boundaries and AN and BN behaviors and cognitions in a group of at-risk college age females. This study is part of a larger series of similar studies with adolescent and college age females so that age related developmental comparisons in the individuation/ attachment process can be identified. We expected to find that attachment/individuation variables as a set would mediate between overall enmeshed/disengaged family boundaries and both concerns with thinness and bulimia behaviors in these college females. We also expected that individuation behaviors would have a stronger unique effect than attachment concerns for these participants because of their status as young adults rather than as teenagers.